2016-11-14T08:19:23-06:00 2015-12-31 621517792 PERSHING YOAKLEY & ASSOCIATES P C 2220 SUTHERLAND AVE KNOXVILLE TN 37919 990 2015-01-01 566024172 HEALTHCARE FOUNDATION OF WILSON HEAL 2522812105 PO BOX 3697 WILSON NC 27895 DENISE O'HARA EXECUTIVE DIRECTOR 2522812105 2016-11-14 1 DEBORAH O ERNSBERGER P00364912 8656730844 2015 2017-02-10 21:41:12Z DENISE O'HARA PO BOX 3697 WILSON NC 27895 23102218 0 X HTTPS://HEALTHCAREFOUNDATIONOFWILSON.ORG/ X 1964 NC TO SUPPORT THE HEALTH CARE NEEDS OF THE PEOPLE OF WILSON COUNTY AND NEIGHBORING COMMUNITIES. 16 16 3 15 0 0 7217 51474 131325 11548684 2758228 11472348 1062 29111 2897832 23101617 12630 54120 0 0 83725 209513 0 0 0 94794 615052 191149 878685 2706683 22222932 149892256 147476872 7553789 4844435 142338467 142632437 X HEALTHCARE FOUNDATION OF WILSON (THE FOUNDATION) INVESTS IN COLLABORATIVE EFFORTS THAT IMPACT AND MEASURABLY IMPROVE THE HEALTH AND WELL-BEING OF ALL WILSON COUNTY RESIDENTS. 0 0 506166 54120 11548684 THE FOUNDATION SERVES AS A HEALTH LEGACY CHARITABLE FOUNDATION TO SUPPORT THE HEALTH CARE NEEDS OF ITS COMMUNITY AND MAINTAINS ASSETS ASSOCIATED WITH THE WILSON MEDICAL CENTER, INC. FACILITY. THE FOUNDATION PROVIDES GRANT-MAKING WITH THE OBJECTIVE OF IMPROVING HEALTH AND WELLNESS WITH THE FOLLOWING FOUR FOCUS AREAS:- ADOLESCENT PREGNANCY EDUCATION AND PREVENTION;- ALCOHOL AND SUBSTANCE ABUSE IN YOUTHS;- OBESITY PREVENTION; AND- SEXUALLY TRANSMITTED DISEASE PREVENTION.ADDITIONALLY, AS DESCRIBED IN DETAIL IN SCHEDULE A, PART VI, THE FOUNDATION RETAINS AN OWNERSHIP INTEREST AND EFFECTIVE CONTROL OF DLP WILSON HOLDING COMPANY, LLC, WHICH OPERATES THE HOSPITAL AND NURSING HOME PREVIOUSLY OWNED AND OPERATED BY THE FOUNDATION. THROUGH ITS OWNERSHIP OF DLP WILSON HOLDING COMPANY, LLC, THE FOUNDATION CONTINUES TO SUPPORT PROGRAMS THAT FOSTER THE DELIVERY, QUALITY, OR AFFORDABILITY OF HEALTH CARE OR HEALTH CARE-RELATED SERVICES AND TO SUPPORT ANY ACTIVITY DESIGNED AND CARRIED ON TO SERVE THE GENERAL HEALTH AND WELL-BEING OF THE COMMUNITY; TO AID IN THE INSTRUCTION AND PROMOTION OF RESEARCH AND SCIENTIFIC INVESTIGATION IN ALL BRANCHES OF MEDICINE AND SURGERY; AND TO SUPPORT ANY EDUCATIONAL ACTIVITIES RELATED TO THE CARE OF THE SICK AND DISABLED, THE PROMOTION OF HEALTH AND PREVENTATIVE MEDICINE, AND THE GENERAL HEALTH AND WELL-BEING OF THE COMMUNITY. 506166 1 1 0 0 0 0 0 0 0 0 1 1 1 0 1 1 1 0 0 0 0 0 0 0 1 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 17 0 1 3 1 0 0 0 0 0 0 0 0 0 0 X 16 16 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 1 1 1 1 NC X DENISE O'HARA 2522812105 PO BOX 3697 WILSON NC 27895 CARLETHA WARD TRUSTEE 1.00 X 0 0 0 CARROLL COLEMAN TRUSTEE 1.00 X 0 0 0 FRANK BATTEN DVM CHAIR 1.00 X 0 0 0 GEORGE ISAACS MD TRUSTEE 1.00 X 0 0 0 HUITT MATTOX MD TRUSTEE 1.00 X 0 0 0 JEROME VICK TRUSTEE 1.00 X 0 0 0 JOHN ANTHONY TRUSTEE 1.00 X 0 0 0 JONATHON DEWALD MD TRUSTEE 1.00 X 0 0 0 LEESA LAWRENCE MD TRUSTEE 1.00 X 0 0 0 TOMMY SHINGLETON TRUSTEE 1.00 X 0 0 0 JERRY WOODARD MD TRUSTEE 1.00 X 0 0 0 KEITH LERRO MD TRUSTEE 1.00 X 0 0 0 THOMAS LUCAS TRUSTEE 1.00 X 0 0 0 SHERYLETTA LACEWELL SECRETARY 1.00 X 0 0 0 JOHN TILTON TREASURER 1.00 X 0 0 0 VANCE FORBES VICE CHAIR 1.00 X 0 0 0 DENISE O'HARA EXECUTIVE DIRECTOR 40.00 X 151963 0 56241 RICHARD HUDSON FORMER CEO 0.00 X 273273 0 10369 425236 0 66610 2 1 1 0 WOMBLE CARLYLE SANDRIDGE & RICE LLP PO BOX 607879 CHARLOTTE NC 28260 LEGAL SERVICES 100693 RSM US LLP 5155 PAYSPHERE CIRCLE CHICAGO IL 60674 ACCOUNTING SERVICES 100658 2 51474 51474 PATIENT SERVICE REVENUE 621110 11575454 11575454 DISCONTINUED OPERATIONS 621110 -26770 -26770 11548684 11472348 11472348 29412 601 28811 28811 OTHER INCOME 900099 300 300 300 23101617 11548684 0 11501459 X 54120 54120 151963 136767 15196 19116 17204 1912 35853 32268 3585 2581 2323 258 163179 163179 162503 162503 117486 105737 11749 11001 9901 1100 18006 16205 1801 8046 7241 805 1149 1149 58296 52466 5830 SUPPLIES 27148 24433 2715 SPECIAL EVENTS 20033 20033 COMMUNITY HEALTH INITIA 9353 9353 PENSION LIQUIDATION 7363 6627 736 11489 10339 1150 878685 506166 372519 0 10760376 8294092 11755666 1575160 172238 74317 84759 49288 8100 0 41188 110235814 121559424 14907003 16807837 583920 517334 149892256 147476872 1409954 466396 6143835 4378039 7553789 4844435 X 142338467 142031474 600963 142338467 142632437 149892256 147476872 X 22222932 -12429267 -9499695 X 0 1 X 1 0 X PART I, LINE 3 THE HEALTHCARE FOUNDATION OF WILSON AND WILMED GENERATIONS, INC. ENTERED INTO AN AGREEMENT WITH DLP HEALTHCARE, LLC, IN 2014 TO FORM A JOINT VENTURE, DLP WILSON HOLDING COMPANY, LLC, THAT WOULD OPERATE THE HOSPITAL AND NURSING HOME PREVIOUSLY OWNED AND OPERATED BY THE FOUNDATION AND WILMED GENERATIONS, INC. THE FOUNDATION THEREFORE CEASED DIRECTLY PROVIDING HEALTH CARE SERVICES AND PROVIDES MEDICAL SERVICES INDIRECTLY THROUGH THE JOINT VENTURE. THE GOVERNING DOCUMENTS OF THE JOINT VENTURE REQUIRE THAT THE JOINT VENTURE OPERATE THE HOSPITAL IN A MANNER AS TO SATISFY THE CHARITABLE PURPOSES GENERALLY REQUIRED OF HOSPITALS RECOGNIZED AS EXEMPT UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE, INCLUDING THE FOLLOWING: - THE HOSPITAL ACCEPT MEDICARE AND MEDICAID PATIENTS, - MAINTAIN AN EMERGENCY DEPARTMENT THAT ACCEPTS ALL PATIENTS REGARDLESS OF THEIR ABILITY TO PAY, - ADOPT THE CHARITY CARE POLICIES UTILIZED BY THE FOUNDATION PRIOR TO THE TRANSFER OF THE HOSPITAL TO THE JOINT VENTURE, AND - COMPLY WITH THE REQUIREMENTS OF SECTION 501(R) OF THE INTERNAL REVENUE CODE REGARDING CHARITY CARE AND FINANCIAL ASSISTANCE POLICIES AND THE CONDUCTING OF COMMUNITY HEALTH NEEDS ASSESSMENTS. THE GOVERNING DOCUMENTS OF THE JOINT VENTURE INCLUDE PROVISIONS WHICH PROVIDE THE FOUNDATION, THROUGH ITS REPRESENTATIVES ON THE GOVERNING BODY OF THE JOINT VENTURE, WITH THE POWER TO ENFORCE COMPLIANCE WITH THESE CHARITABLE HOSPITAL REQUIREMENTS. THE FOUNDATION WAS ALSO A "PUBLIC HOSPITAL" PURSUANT TO CHAPTER 131E, ARTICLE 2, OF THE NORTH CAROLINA GENERAL STATUTES (PUBLIC HOSPITAL STATUTES). THE PUBLIC HOSPITAL STATUTES AT THE TIME OF CREATION OF THE JOINT VENTURE REQUIRED THAT ANY TRANSFER OF A PUBLIC HOSPITAL FACILITY MUST BE MADE TO A CORPORATION, AND THE PUBLIC HOSPITAL STATUTES DID NOT PERMIT THE TRANSFER OF A PUBLIC HOSPITAL FACILITY TO A LIMITED LIABILITY COMPANY. WITH THE CREATION OF THIS JOINT VENTURE IN MIND, THE NORTH CAROLINA GENERAL ASSEMBLY PASSED A TECHNICAL CORRECTIONS STATUTE WHICH ENABLED THE TRANSFER OF A PUBLIC HOSPITAL FACILITY TO BE MADE TO A LIMITED LIABILITY COMPANY AS WELL AS TO A CORPORATION. THE EFFECTIVE DATE OF THE NORTH CAROLINA GENERAL ASSEMBLY'S CHANGE TO THE PUBLIC HOSPITAL STATUTE WAS AFTER THE CREATION OF THE JOINT VENTURE. IN ORDER TO COMPLY WITH THE REQUIREMENTS OF THE PUBLIC HOSPITAL STATUTE AT THAT TIME, THE HOSPITAL FACILITY WAS TRANSFERRED TO DLP WILSON MEDICAL CENTER, INC., WHICH WAS WHOLLY OWNED BY THE JOINT VENTURE, WITH THE INTENTION THAT DLP WILSON MEDICAL CENTER, INC. WOULD BE CONVERTED TO A LIMITED LIABILITY COMPANY AFTER THE ENACTMENT OF THE NORTH CAROLINA GENERAL ASSEMBLY'S TECHNICAL CORRECTION TO THE NORTH CAROLINA PUBLIC HOSPITAL STATUTES. AFTER THE CONVERSION OF THE DLP WILSON MEDICAL CENTER, INC. TO A LIMITED LIABILITY COMPANY, IT WAS TREATED AS A DISREGARDED ENTITY FOR FEDERAL TAX PURPOSES, AND THE JOINT VENTURE IS TREATED AS OPERATING THE HOSPITAL DIRECTLY. THE NORTH CAROLINA PUBLIC HOSPITAL STATUTES ALSO REQUIRE THAT THE JOINT VENTURE, AS THE TRANSFEREE OF THE PUBLIC HOSPITAL FACILITY, CONTINUE TO PROVIDE THE SAME HOSPITAL SERVICES, INDIGENT CARE, FINANCIAL ASSISTANCE POLICIES, AND MEDICARE AND MEDICAID SERVICES AS WERE PROVIDED BY THE FOUNDATION PRIOR TO THE TRANSFER, AND THE JOINT VENTURE IS REQUIRED TO PROVIDE AN ANNUAL REPORT THAT SHOWS COMPLIANCE WITH THIS REQUIREMENT. FAILURE TO COMPLY WITH THIS REQUIREMENT WILL CAUSE THE HOSPITAL FACILITY TO REVERT TO WILSON COUNTY. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 49288 8100 41188 41188 INVESTMENTS 121559424 F 121559424 INVESTMENT IN DLP WILSON HOLDING COMPANY, LLC 16807837 F 16807837 DEFERRED COMPENSATION 272465 DUE TO THIRD PARTY 2499404 ENVIRONMENTAL REMEDIATION LIABILITY 1606170 4378039 X 1169845 -12429267 601 -12428666 13598511 9503106 9503106 23101617 875875 601 601 875274 3411 3411 878685 PART X, LINE 2: THE FOUNDATION IS A NONPROFIT ORGANIZATION EXEMPT FROM INCOME TAXES UNDER INTERNAL REVENUE CODE SECTION 501(C)(3). THE FOUNDATION DOES NOT HAVE ANY MATERIAL UNRECOGNIZED TAX BENEFITS OR OBLIGATIONS AS OF DECEMBER 31, 2015. IT IS THE FOUNDATION'S POLICY TO EVALUATE ALL TAX POSITIONS TO IDENTIFY ANY THAT MAY BE CONSIDERED UNCERTAIN. NO MATERIAL UNCERTAIN TAX POSITIONS WERE IDENTIFIED FOR 2015 THAT WOULD REQUIRE RECOGNITION OR DISCLOSURE IN THE FINANCIAL STATEMENTS. PART XI, LINE 2D - OTHER ADJUSTMENTS: FUNDRAISING EXPENSES IN REVENUE 601. PART XI, LINE 4B - OTHER ADJUSTMENTS: PARTNERSHIP BOOK-TAX DIFFERENCE 9,503,106. PART XII, LINE 2D - OTHER ADJUSTMENTS: FUNDRAISING EXPENSES IN REVENUE 601. PART XII, LINE 4B - OTHER ADJUSTMENTS: PARTNERSHIP BOOK-TAX DIFFERENCE 3,411. AUXILIARY - UNIFORM AND JEWELRY 29412 29412 601 29412 29412 601 601 28811 1 1 1 X 1 X 1 1 1 0 1 1 778758 778758 0.00600 778758 778758 0.00600 2653170 2653170 0.02050 72392 72392 0.00060 43227 43227 0.00030 2768789 2768789 0.02140 3547547 3547547 0.02740 10279 10279 0.00010 138000 138000 0.00110 148279 148279 0.00120 0 43601039 10624716 37364775 43181298 -5816523 X 1 1 1 1 DLP WILSON MEDICAL CENTER 1705 TARBORO STREET SW WILSON NC 27893 X X X DLP WILSON MEDICAL CENTER 1 0 0 1 X X X X X X X X X 13 1 0 0 1 X HTTPS://HEALTHCAREFOUNDATIONOFWILSON.ORG X HTTP://WWW.WILSON-CO.COM/85/HEALTH-DEPARTMENT X 1 13 1 HTTPS://HEALTHCAREFOUNDATIONOFWILSON.ORG 0 0 1 X 200.000000000000 300.000000000000 X X X X X 1 1 X X X X 1 X HTTP://WWW.WILSONMEDICAL.COM/ABOUT-US/CHARITY-CARE-POLICY X HTTP://WWW.WILSONMEDICAL.COM/ABOUT-US/CHARITY-CARE-POLICY X X X X X 1 X 0 X X X X 1 X 0 0 DLP WILSON MEDICAL CENTER PART V, SECTION B, LINE 5: WILSON MEDICAL CENTER WAS A PART OF A COMMUNITY-BASED ASSESSMENT CONDUCTED BY THE WILSON COUNTY COMMUNITY HEALTH ASSESSMENT TEAM. THE HEALTH ASSESSMENT NEEDS OF THE COMMUNITY WERE DETERMINED BY THE WILSON COUNTY COMMUNITY. IN 2013, 1,000 WILSON COUNTY HEALTH ASSESSMENT SURVEYS WERE DISTRIBUTED THROUGHOUT THE COUNTY. FIVE HUNDRED AND THIRTEEN (513) RESIDENTS COMPLETED AND RETURNED THE SURVEY. THE DATA WAS COMPILED AND FORMAL PRESENTATIONS WERE MADE TO THE WILSON COUNTY BOARD OF HEALTH AND WILSON MEDICAL CENTER HOSPITAL BOARD OF DIRECTORS. EACH TEAM MEMBER WAS PROVIDED WITH THE OPPORTUNITY TO VOTE ON THE TOP THREE (3) CONCERNS OF THE COMMUNITY OUT OF THE TOP TEN (10) CONCERNS. THE SURVEY WAS ANALYZED BY SURVEY MONKEY. THE WILSON COUNTY BOARD OF HEALTH INCLUDED:-DR. WILLIAM BOLES, III, DDS-DR. ERNESTINE FITCH, MD-DR. MARIE GLENNON, DVM-MICHAEL LAMONDS-GEORGE LEACH-THOMAS LUCAS-DR. JESSICA MCKEE-DR. RUSSELL STONE, OD-RON SUTTON AND-SAMUEL TERUEL-VELEZTHE WILSON COUNTY BOARD OF DIRECTORS INCLUDED:-JIM PRIDGEN-PAGE THOMAS SMITH-CARLETHA WARD-CARROLL COLEMAN-WILLIAM BYNUM, IV, MD-JONATHON DEWALD, MD-SHERYLETTA LACEWELL-LEESA LAWRENCE, MD-THOMAS LUCAS-REV. WILLIAM PRESNELL-TOMMY SHINGLETON-JOHN TILTON, AND -DAVID WEST. DLP WILSON MEDICAL CENTER PART V, SECTION B, LINE 11: WILSON MEDICAL CENTER REVIEWED THE HEALTHCARE NEEDS AND THREE PRIORITY AREAS WERE IDENTIFIED. THEY ARE 1) ACCESS TO CARE, 2) OBESITY, AND 3) SUBSTANCE ABUSE. ACTION PLANS ARE IN PLACE TO ADDRESS THESE NEEDS. OTHER AT-RISK BEHAVIOR IDENTIFIED IN THE CHNA, SUCH AS GANG VIOLENCE, HAS BEEN ADDRESSED BY LAW ENFORCEMENT, AS THEY ARE EQUIPPED AND TRAINED TO DEAL WITH THIS ISSUE. THE ORGANIZATION WILL PROVIDE SUPPORT TO THE LAW ENFORCEMENT DEPARTMENTS AS NEEDED. 2 1 - DLP WILMED NURSING CARE AND REHAB CENTER 1705 TARBORO STREET SW WILSON NC 27893 REHABILITATION CENTER 2 - DLP WILSON PHYSICIAN PRACTICES 1705 TARBORO STREET SW WILSON NC 27893 PHYSICIAN OFFICE PART I, LINE 3C: ELIGIBILITY IS GENERALLY DETERMINED BY MEASURING THE GROSS FAMILY INCOME AGAINST THE FEDERAL POVERTY INCOME GUIDELINES. IN ADDITION, OTHER RELEVANT NON-INCOME RESOURCES, INCLUDING BUT NOT LIMITED TO REAL ESTATE, SAVINGS, LIFE INSURANCE, MOTOR VEHICLES, ETC., WILL BE CONSIDERED IN REACHING A DETERMINATION OF ELIGIBILITY. ELIGIBILITY GUIDELINES WILL ALSO TAKE INTO CONSIDERATION CATASTROPHIC EVENTS FOR PATIENTS WHOSE INCOME FALLS OUTSIDE THE GUIDELINES. PATIENTS WHOSE GROSS INCOME IS LESS THAN THREE TIMES THE FEDERAL POVERTY INCOME GUIDELINES MAY BE ELIGIBLE FOR REDUCED MONTHLY PAYMENTS OR UNCOMPENSATED SERVICES IN PART OR IN FULL. FORM 990, SCHEDULE H EFFECTIVE MARCH 1, 2014, WILSON MEDICAL CENTER, INC. AND WILMED GENERATIONS, INC. ENTERED INTO AN AGREEMENT WITH DLP HEALTHCARE, LLC TO FORM A JOINT VENTURE, DLP WILSON HOLDING COMPANY, LLC, THAT WOULD OPERATE THE HOSPITAL AND NURSING HOME PREVIOUSLY OWNED AND OPERATED BY WILSON MEDICAL CENTER, INC. AND WILMED GENERATIONS, INC. WILSON MEDICAL CENTER, INC. THEREFORE CEASED DIRECTLY PROVIDING HEALTH CARE SERVICES ON FEBRUARY 28, 2014 AND IS PROVIDING MEDICAL SERVICES INDIRECTLY THROUGH THE JOINT VENTURE. EFFECTIVE OCTOBER 1, 2014, WILSON MEDICAL CENTER, INC. CHANGED ITS NAME TO HEALTHCARE FOUNDATION OF WILSON (THE "FOUNDATION"). THE GOVERNING DOCUMENTS OF THE JOINT VENTURE REQUIRE THAT THE JOINT VENTURE OPERATE THE HOSPITAL IN A MANNER AS TO SATISFY THE CHARITABLE PURPOSES GENERALLY REQUIRED OF HOSPITALS RECOGNIZED AS EXEMPT UNDER SECTION 501(C)(3) OF THE CODE, INCLUDING THAT THE HOSPITAL ACCEPT MEDICARE AND MEDICAID PATIENTS, MAINTAIN AN EMERGENCY DEPARTMENT THAT ACCEPTS ALL PATIENTS REGARDLESS OF THEIR ABILITY TO PAY, ADOPT THE CHARITY CARE POLICIES UTILIZED BY WILSON MEDICAL CENTER, INC. PRIOR TO THE TRANSFER OF THE HOSPITAL TO THE JOINT VENTURE, AND COMPLY WITH THE REQUIREMENTS OF SECTION 501(R) OF THE CODE REGARDING CHARITY CARE AND FINANCIAL ASSISTANCE POLICIES AND THE CONDUCTING OF COMMUNITY HEALTH NEEDS ASSESSMENTS. THE GOVERNING DOCUMENTS OF THE JOINT VENTURE INCLUDE PROVISIONS WHICH PROVIDE THE FOUNDATION, THROUGH ITS REPRESENTATIVES ON THE GOVERNING BODY OF THE JOINT VENTURE, WITH THE POWER TO ENFORCE COMPLIANCE WITH THESE CHARITABLE HOSPITAL REQUIREMENTS. WILSON MEDICAL CENTER, INC. WAS ALSO A "PUBLIC HOSPITAL" PURSUANT TO CHAPTER 131E, ARTICLE 2, OF THE NORTH CAROLINA GENERAL STATUTES (THE "PUBLIC HOSPITAL STATUTES"). THE PUBLIC HOSPITAL STATUTES AT THE TIME OF CREATION OF THE JOINT VENTURE REQUIRED THAT ANY TRANSFER OF A PUBLIC HOSPITAL FACILITY MUST BE MADE TO A CORPORATION, AND THE PUBLIC HOSPITAL STATUTES DID NOT PERMIT THE TRANSFER OF A PUBLIC HOSPITAL FACILITY TO A LIMITED LIABILITY COMPANY. WITH THE CREATION OF THIS JOINT VENTURE IN MIND, THE NORTH CAROLINA GENERAL ASSEMBLY PASSED A TECHNICAL CORRECTIONS STATUTE WHICH ENABLED THE TRANSFER OF A PUBLIC HOSPITAL FACILITY TO BE MADE TO A LIMITED LIABILITY COMPANY AS WELL AS TO A CORPORATION. THE EFFECTIVE DATE OF THE NORTH CAROLINA GENERAL ASSEMBLY'S CHANGE TO THE PUBLIC HOSPITAL STATUTE WAS OCTOBER 1, 2014, WHICH WAS AFTER THE CREATION OF THE JOINT VENTURE. IN ORDER TO COMPLY WITH THE REQUIREMENTS OF THE PUBLIC HOSPITAL STATUTE AT THAT TIME, THE HOSPITAL FACILITY WAS TRANSFERRED TO DLP WILSON MEDICAL CENTER, INC., WHICH WAS WHOLLY OWNED BY THE JOINT VENTURE, WITH THE INTENTION THAT DLP WILSON MEDICAL CENTER, INC., WOULD BE CONVERTED TO A LIMITED LIABILITY COMPANY AFTER THE ENACTMENT OF THE NORTH CAROLINA GENERAL ASSEMBLY'S TECHNICAL CORRECTION TO THE NORTH CAROLINA PUBLIC HOSPITAL STATUTES, AND THE CONVERSION WAS COMPLETED EFFECTIVE ON DECEMBER 31, 2014. AFTER THE CONVERSION OF THE DLP WILSON MEDICAL CENTER, INC., TO A LIMITED LIABILITY COMPANY, IT WAS TREATED AS A DISREGARDED ENTITY FOR FEDERAL TAX PURPOSES, AND THE JOINT VENTURE IS TREATED AS OPERATING THE HOSPITAL DIRECTLY. THE NORTH CAROLINA PUBLIC HOSPITAL STATUTES ALSO REQUIRE THAT THE JOINT VENTURE, AS THE TRANSFEREE OF THE PUBLIC HOSPITAL FACILITY, CONTINUE TO PROVIDE THE SAME HOSPITAL SERVICES, INDIGENT CARE, FINANCIAL ASSISTANCE POLICIES, AND MEDICARE AND MEDICAID SERVICES AS WERE PROVIDED BY WILSON MEDICAL CENTER, INC. PRIOR TO THE TRANSFER, AND THE JOINT VENTURE IS REQUIRED TO PROVIDE AND ANNUAL REPORT THAT SHOWS COMPLIANCE WITH THIS REQUIREMENT. FAILURE TO COMPLY WITH THIS REQUIREMENT WILL CAUSE THE HOSPITAL FACILITY TO REVERT TO WILSON COUNTY.THE INFORMATION REPORTED ON SCHEDULE H REPRESENTS FINANCIAL DATA AS PROVIDED BY THE JOINT VENTURE HOSPITAL AND NON-HOSPITAL FACILITIES. PERCENTAGES OF COMMUNITY BENEFIT REPRESENT COMMUNITY BENEFIT (AT COST) AS A PERCENTAGE OF TOTAL JOINT VENTURE EXPENSES, INCLUDING DLP WILSON MEDICAL CENTER, LLC, DLP WILMED NURSING CARE AND REHABILITATION CENTER, LLC AND DLP WILSON PHYSICIAN PRACTICES, LLC. PART II, COMMUNITY BUILDING ACTIVITIES: THE "WILSON CHAMBER OF COMMERCE" PROGRAM PROVIDES FOR THE DEVELOPMENT AND GROWTH OF THE CITY OF WILSON, NORTH CAROLINA. PART III, LINE 2: THE COMPANY HAS AN ESTABLISHED PROCESS TO DETERMINE THE ADEQUACY OF THE ALLOWANCE FOR BAD DEBTS THAT RELIES ON A NUMBER OF ANALYTICAL TOOLS AND BENCHMARKS TO ARRIVE AT A REASONABLE ALLOWANCE. NO SINGLE STATISTIC OR MEASUREMENT DETERMINE THE ADEQUACY OF THE ALLOWANCE FOR BAD DEBTS. SOME OF THE ANALYTICAL TOOLS THAT THE COMPANY UTILIZES INCLUDE, BUT ARE NOT LIMITED TO, HISTORICAL CASH COLLECTION EXPERIENCE, REVENUE TRENDS BY PAYOR CLASSIFICATION, AND REVENUE DAYS IN ACCOUNTS RECEIVABLE. PART III, LINE 3: THE AMOUNT ATTRIBUTABLE TO CHARITY IS $3,481,248, AND THE AMOUNT ATTRIBUTABLE TO UNCOMPENSATED CARE IS $7,143,468. PART III, LINE 4: THE WILSON MEDICAL CENTER, INC. PROVIDES SERVICES TO THE RESIDENTS OF WILSON AND SURROUNDING COUNTIES WITHOUT COLLATERAL. AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS IS PROVIDED IN AN AMOUNT EQUAL TO THE ESTIMATED LOSSES TO BE INCURRED IN COLLECTION OF THE RECEIVABLES. PART III, LINE 8: COSTS ARE DETERMINED USING THE STEP-DOWN METHOLODOGY FROM THE MEDICARE COST REPORT. PART III, LINE 9B: PATIENTS IDENTIFIED AS QUALIFYING FOR CHARITY CARE HAVE THEIR ACCOUNTS ADJUSTED AND ARE NOT SUBJECTED TO COLLECTION EFFORTS. PART VI, LINE 4: BASED ON THE 2013 CENSUS ESTIMATES FOR WILSON COUNTY THERE ARE 81,667 PEOPLE; 31,932 HOUSEHOLDS; AND 21,292 FAMILIES. THE POPULATION DENSITY WAS 220.6 PEOPLE PER SQUARE MILE. THERE WERE 35,514 HOUSING UNITS. THE RACIAL MAKEUP OF THE COUNTY WAS WHITE (NOT HISPANIC/LATINO), 48.8%; BLACK OR AFRICAN AMERICAN, 39.6%; NATIVE AMERICAN, .5%; ASIAN, 1%; PACIFIC ISLANDER, .1%; HISPANIC OR LATINO, 10%. PEOPLE OF TWO OR MORE RACES ACCOUNTED FOR 1.4%.OF THE 31,932 HOUSEHOLDS, 28.2% FAMILIES WITH CHILDREN OF THEIR OWN WERE UNDER 18 YEARS OLD. 45% OF THEM WERE MARRIED COUPLES LIVING TOGETHER. 16.4% HAD A FEMALE HEAD OF HOUSEHOLD WITH NO HUSBAND PRESENT. 33.3% WERE NON FAMILIES. 11.1% OF THE HOUSEHOLDS WERE MADE UP OF SOMEONE LIVING ALONE WHO IS 65 YEARS OF AGE AND OLDER. THE AVERAGE HOUSEHOLD SIZE WAS 2.48. THE AVERAGE FAMILY SIZE WAS 3.05.THE 81,667 PEOPLE WERE BROKEN DOWN IN THESE AGE GROUPS: 19,429 WERE UNDER THE AGE OF 18, 7,425 ARE AGED 18 TO 24 YEARS OLD, 19,416 ARE AGED 25 TO 44 YEARS OLD, 22,342 WERE AGED 46 TO 64 YEARS OLD, 13,055 WERE 65 YEARS OLD AND OLDER, AND 1,627 ARE PEOPLE AGED 85 YEARS OLD AND OLDER. THE MEDIAN AGE IS 39.8.OF THE 81,667 PEOPLE, 38,881 WERE MALE AND 42,786 WERE FEMALE. OF THE 62,238 PEOPLE AGED 18 AND OLDER, 28,913 WERE MALE AND 33,325 WERE FEMALE.THE MEDIAN INCOME FOR A HOUSEHOLD IN THE COUNTY WAS $38,398. THE MEDIAN INCOME FOR FAMILY WAS $47,647. MALES HAD A MEDIAN INCOME OF $38,297 VERSUS $30,861 FOR FEMALES. THE PER CAPITA INCOME FOR THE COUNTY WAS $20,671. 17% OF THE FAMILIES IN THE COUNTY LIVE BELOW THE POVERTY LINE. 22.8% OF THE POPULATION LIVES BELOW THE POVERTY LINE. 19.1% OF THOSE OVER THE AGE OF 18 LIVE BELOW THE POVERTY LINE. 12.6% OF THOSE AGED 65 AND OLDER LIVE BELOW THE POVERTY LINE. PART VI, LINE 5: DLP WILSON MEDICAL CENTER HAS AN OPEN MEDICAL STAFF. THE BOARD OF TRUSTEES IS COMPRISED OF INDIVIDUALS THAT ARE ACTIVE IN OTHER ORGANIZATIONS IN THE COMMUNITY. SURPLUS FUNDS ARE REINVESTED IN THE FACILITY AND EQUIPMENT THAT PROVIDE HEALTHCARE SERVICES. HEALTHCARE FOUNDATION OF WILSON'S (HFW) BOARD OF DIRECTORS IS ALSO COMPRISED OF INDIVIDUALS ACTIVE IN OTHER ORGANIZATIONS IN THE COMMUNITY. IN ADDITION, HFW, IN COLLABORATION WITH THE LOCAL HEALTH DEPARTMENT, PROVIDES FREE FLU VACCINATIONS TO INDIVIDUALS IN THE COMMUNITY WHO DO NOT HAVE HEALTH INSURANCE COVERAGE. VACCINATIONS ARE PROVIDED FREE OF CHARGE, THEREBY REINVESTING IN HEALTHCARE SERVICES TO PROMOTE THE HEALTH OF THE COMMUNITY. PART VI, LINE 6: N/A 1 WILSON COUNTY HEALTH DEPARTMENT 1801 GLENDALE DRIVE WILSON NC 27893 566000351 115 20000 BREAST AND CERVICAL CANCER CONTROL PROGRAM 1 PART I, LINE 2: THE ORGANIZATION PROVIDES FUNDS IN FURTHERANCE OF ITS MISSION TO SUPPORT THE HEALTH CARE NEEDS WITHIN ITS COMMUNITY. THE EXECUTIVE DIRECTOR OVERSEES EXPENDITURES OF ALL FUNDS, AND REPORTS ARE PRESENTED AT BOARD MEETINGS. X X X X 1 0 0 0 0 0 0 0 0 DENISE O'HARA EXECUTIVE DIRECTOR 135000 0 0 0 16963 0 52191 0 4050 0 208204 0 0 0 RICHARD HUDSON FORMER CEO 0 0 0 0 273273 0 0 0 10369 0 283642 0 0 0 PART I, LINE 4A DENISE O'HARA, EXECUTIVE DIRECTOR - $16,963 SEVERANCE IN RELATION TO DUTIES PERFORMED FOR WILSON MEDICAL CENTER, INC. PRIOR TO THE OWNERSHIP CHANGE AS DESCRIBED IN FURTHER DETAIL IN SCHEDULES A, H, AND O. RICHARD HUDSON, FORMER OFFICER - $273,273 SEVERANCE IN RELATION TO DUTIES PERFORMED FOR WILSON MEDICAL CENTER, INC. PRIOR TO HIS DEPARTURE. FORM 990, PART VI, SECTION B, LINE 11 A DRAFT OF FORM 990 IS PROVIDED TO THE EXECUTIVE DIRECTOR AND LEGAL COUNSEL WHO REVIEW THE DRAFT PRIOR TO FILING WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C ONCE A YEAR, EACH PERSON IS REQUIRED TO REVIEW AND SIGN THE CONFLICT OF INTEREST POLICY. IF THERE IS A CONFLICT OF INTEREST, THE EXECUTIVE DIRECTOR IS NOTIFIED AND A DISCUSSION SHOULD OCCUR AT THAT TIME TO DETERMINE THE EXTENT, WHETHER POTENTIAL OR ACTUAL. BOARD MEMBERS WITH CONFLICTS ARE RECUSED FROM VOTING. FORM 990, PART VI, SECTION B, LINE 15 AT LEAST EVERY TWO YEARS, AN INDEPENDENT SURVEY IS UTILIZED TO DETERMINE THE APPROPRIATE COMPENSATION FOR THE EXECUTIVE DIRECTOR. THE BOARD DETERMINES A STRATEGY AND GUIDELINES AS TO WHAT PERCENTILE AT WHICH THEY WOULD PLACE SALARY FOR THE EXECUTIVE DIRECTOR. UPON RECEIPT OF THE INDEPENDENT DATA, THE HUMAN RESOURCES COMMITTEE OF THE BOARD REVIEWS THE DATA AND DETERMINES IF ANY ADJUSTMENTS SHOULD BE MADE. THIS PROCESS LAST TOOK PLACE DURING 2015. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS, POLICIES AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. FORM 990, PART IX, LINE 11G PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 105,737. MANAGEMENT AND GENERAL EXPENSES 11,749. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 117,486. FORM 990, PART XI, LINE 9: PARTNERSHIP BOOK-TAX DIFFERENCE -9,499,695. DLP WILSON HOLDING COMPANY LLC 330 SEVEN SPRINGS WAY BRENTWOOD TN 37027 901034226 PROVIDING HEALTH CARE AND OTHER HEALTH RELATED SERVICES NC N/A RELATED 11569959 0 0 0.20000 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 DLP WILSON HOLDING COMPANY LLC B 14725511 FAIR MARKET VALUE